Inequalities in the uptake of weight management interventions in a pragmatic trial: an observational study in primary care.
Inequalities in the uptake of weight management interventions in a pragmatic trial: an observational study in primary care.
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DOI：
10.3399/bjgp16x684337
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
WRAP trial team
中科院分区：
文献类型：
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作者：
Ahern AL;Aveyard P;Boyland EJ;Halford JC;Jebb SA;WRAP trial team
初级保健转介到商业开放团体行为减肥计划是一种具有成本效益的干预措施，但接受这种干预的患者中只有10%是男性。探讨观察到的参与这些干预措施的偏见是否反映了偏见的邀请参加。比较邀请人群和招募参与者在一项多中心随机对照试验的初级保健转介到一个商业开放组行为减肥计划在英格兰（WRAP [减肥转介成人在初级保健]）。在2012年10月至2014年2月期间，参与者通过英格兰的23个初级保健实践招募; 17个实践提供了有关受邀参与者特征的数据。女性入组试验的可能性是男性的两倍（比值比[OR] 2.01，95%置信区间[CI] = 1.75至2.32）。然而，男性的比例是常规初级保健转诊或机会性邀请患者的类似试验的三倍。贫困程度较低地区的人比贫困程度较高地区的人更有可能入学（OR 1.77，95%CI = 1.55至2.03）。老年患者（≥40岁）比年轻患者更有可能入组（OR 1.60，95% CI = 1.34 - 1.91）。男性、年轻人和来自贫困地区的人不太可能接受邀请参加本试验。性别偏见小于在常规做法中观察到的，这表明以前观察到的不公平的很大一部分是关于提供干预的偏见的结果。这项研究表明，克服大部分性别偏见的一个简单方法是写信给超重的患者并提供转诊。社会经济地位较低的群体对参与邀请的接受程度较低，这表明需要优先向这一群体提供转诊，以减少健康不平等，并进行研究，探讨接受邀请的障碍。
Primary care referral to a commercial open-group behavioural weight-loss programme is a cost-effective intervention, but only 10% of patients receiving this intervention are male. To explore whether observed biases in participation in these interventions reflect biases in the uptake of the invitation to participate. Comparison of invited population and recruited participants in a multicentre randomised controlled trial of primary care referral to a commercial open-group behavioural weight-loss programme in England (WRAP [Weight loss Referrals for Adults in Primary care]). Between October 2012 and February 2014, participants were recruited through 23 primary care practices in England; 17 practices provided data on the characteristics of invited participants. Females were twice as likely as males to enrol in the trial (odds ratio [OR] 2.01, 95% confidence interval [CI] = 1.75 to 2.32). However, the proportion of males was threefold higher than seen in routine primary care referrals or similar trials that invited patients opportunistically. People from less deprived areas were more likely to enrol than those in more deprived areas (OR 1.77, 95% CI = 1.55 to 2.03). Older patients (≥40 years) were more likely to enrol than younger patients (OR 1.60, 95% CI = 1.34 to 1.91). Males, younger people, and those from more deprived areas were less likely to take up the invitation to participate in this trial. The gender bias was smaller than observed in routine practice, suggesting that a substantial proportion of the inequity observed previously is a consequence of bias with regard to the offer of intervention. This study suggests that a simple way to overcome much of the gender bias is to write to patients who are overweight and offer referral. Uptake of the invitation to participate was lower in groups of lower socioeconomic status suggesting the need to preferentially offer referrals to this group to reduce health inequalities and for research to explore barriers to uptake.